This is a pretty specific query, but the members here are extremely knowledgeable about dietary issues so I'll ask.

How would someone go about lowering the triglycerides in their diet? Or more accurately, what foods should someone eat if they are concerned about triglycerides? This is an "asking for a friend" question, that is really asking for a friend.

Some info to consider- the person had at one time an extremely high potassium level (to the point doctors were extremely concerned) , but that has since leveled out. Said person also drinks heavily (10+- drinks a night, every night.) Pack a day smoker, who has been diagnosed and successfully treated for cancer twice. (Melanoma and colon cancer, but also underwent a medical procedure to remove a pre-cancerous lesion on their prostate, resulting in removal of most ( or maybe all, I'm not sure) of their prostate.) And as of late, they have been vomiting regularly.

This person is older, and morality concerns about diet are not even considered, but they do (despite the smoking and drinking..) try to do what is necessary to keep living a bit longer.

Any recommendations for the triglyceride issues?

(before someone asks, this person is going to an actual doctor less than 24 hours from this post, he's just concerned and I said I would ask the most knowledgeable people I know about what foods he could/should eat.

Eco-atkins (low carb vegan, mostly vegetables with some beans, nuts, and mock meats) is about the most extreme dietary intervention you can get.

But him continuing to drink and trying to resolve the issue with dietary intervention is like somebody trying to bail out a flooding boat but it turns out the boat is flooding because it's anchored under a waterfall and it just needs to move over a couple feet.
If he stops drinking, dietary intervention is likely to do a very good job. If not, well... it might give him a few more weeks, but it's not going to negate the problems caused by alcoholism.

If he's a heavy drinker, he may need to taper off and have a doctor's help in quitting too. But kicking alcohol or at least reducing it as much as possible is going to be essential.
Quitting smoking is also pretty important; see if he'll switch over to vaping... if he wants to live longer. That should at least reduce oxidative stress.

I've tried to suggest both quitting smoking and drinking. I'm working on both myself, so I thought it would help if we both attempted, but he's pretty set in his ways. Unless the doctors tell him "you need to quit now or you'll die in a year", he's not going to do it. Surprisingly, he has had his liver checked, and despite his vast alcohol consumption, it's in good shape for a man his age; akin to one who doesn't drink... go figure.

But since he will do anything to not give up drinking, maybe he will at least change his diet.

The high triglycerides are probably due to the high alcohol consumption, but lower intake of simple sugars and refined carbs also tends to reduce triglycerides.

Thanks Carnap.

I've tried to tell him that he should lay off the drinking, but it hard for the pot to tell the kettle that it's black.... even though I have tried. i have an aged bourbon my hands as i make this post, so...

Lets pretend for a moment that said person doesn't have a chronic addiction to alcohol.

The alcohol is a simple carb overload, so he needs to compensate with a very low net carb diet (fiber is OK). Most of the rest of his calories need to come from fat. But getting those calories from saturated fat won't be much better, it needs to be very unsaturated fats to keep his total % of calories from saturated fat low.
Even fish, which is comparatively low in saturated fat among meats, is high in saturated fat when fat makes up most of your diet.

His diet would be mostly veggies and mock meats. No sweet fruit except blackberries. Olives & avocado are OK.
No coconut (saturated fat will get too high; most of your calories have to come from fat and it adds up fast, which is why non-vegan Atkins is a no-go).
No root veggies (no potatoes, no carrots (too much sugar)). He'll probably need to make sure to take a multivitamin, being sure it has vitamin A and plenty of B-12.

If you get carbs low enough (except the alcohol which is a carb) without eating much saturated fat it should lower triglycerides and risk.
It's a very limiting and not at all easy to do diet. It's also potentially more expensive. Even most vegans who do a low carb diet get saturated fat too high. I can't believe anybody would stick to that just to keep drinking in excess and I doubt a doctor would ever recommend it, because it's just not realistic to expect patients to do it and the best thing he could do is quit drinking.

I can't believe anybody would stick to that just to keep drinking in excess and I doubt a doctor would ever recommend it, because it's just not realistic to expect patients to do it and the best thing he could do is quit drinking.

You'd be surprised to learn what he will do to continue drinking. He slowed down for chemo, but as soon as he felt better went right back to it. I'll let him know the dietary restrictions if he wishes to keep drinking, and my guess is he'll try them. Until a doctor tells him he HAS to quit drinking, he won't.

The problem here is not everyone is the same, what may significantly raise triglycerides in one person may have only a moderate impact on another. But as I noted, generally speaking high intake of simple sugars and refined carbs (or high-glycemic cards as a whole) tends to increase your triglycerides.

I would guess for someone drinking a lot of alcohol focusing on lean meats, vegetables and fatty plant foods would lower triglycerides the best.

But getting those calories from saturated fat won't be much better, it needs to be very unsaturated fats to keep his total % of calories from saturated fat low.Even fish, which is comparatively low in saturated fat among meats, is high in saturated fat when fat makes up most of your diet.

A high intake of saturated fat may increase is total cholesterol but it typically doesn't have a significant impact on your triglycerides.

And I'm not sure what you're trying to say about fish but it doesn't appear accurate, even if you look at a fatty fish like salmon you'd have to eat around 1,4000 calories worth to exceed the recommendation for saturated fat. But most fish is leaner. In contrast many mock meats have higher amounts of saturated fat, in some cases on par with beef.

One can easily do a non-vegan Aktins style diet while eating a good deal of meat and keeping saturated fat below recommendations, you'd just focus more on fish and lean cuts of meat and use plant oils (or whole foods) that are low in saturated fat.

A high intake of saturated fat may increase is total cholesterol but it typically doesn't have a significant impact on your triglycerides.

Both impact the risk factors he's concerned with: dying of cardiovascular disease. It doesn't make sense to decrease triglycerides only to spike your cholesterol, and improving his cholesterol even more (even if it's OK right now) can lower his risk a little. There are diminishing returns and focusing on triglycerides makes more sense, because that's going to give him the most bang for his buck, but if he wants to keep drinking so much he's going to need to have phenomenal cholesterol scores to make up for the inevitably high triglycerides (even on a low carb diet).

And I'm not sure what you're trying to say about fish but it doesn't appear accurate, even if you look at a fatty fish like salmon you'd have to eat around 1,4000 calories worth to exceed the recommendation for saturated fat.

On a low carb diet, most of your calories need to come from fat, not protein. Vegetable fat alone gets you pretty close to the limit, it takes very little to push you over. You need to look at the saturated fat ratio in the fats anything contributes.

Fish fat is simply more saturated than the preferable vegetable fats (like canola). 6 grams saturated out of 27 total, which is 22%.
Compare to something like Walnuts, at 4.9 grams saturated out of 52 total, which is slightly under 10%.

Fish is not a good choice. It does contain DHA/EPA which partially make up for that, but he could take an algae based supplement instead.

The point is that ANY animal fats, even coming from lean meat, will negatively influence your ratio, which is hard enough to keep low with such high consumption of vegetable fats.

Eating a thousand calories of plant fats alone will already have you very close to the max, animal fats easily push that over. And he should probably stay well under the max; a VERY good cholesterol level may help compensate for high triglycerides a little. We're talking about the risk factors for the same diseases.

It's also worth remembering that most animal products contribute dietary cholesterol, which may or may not affect him more than others depending on his genetics, but which none the less should be avoided to minimize his high risk.

In contrast many mock meats have higher amounts of saturated fat, in some cases on par with beef.

That's uncommon. A few like beyond burger do, since they're made with coconut oil. He should not be eating those (although the type of fat in coconut is probably not as bad, it still contributes).
Instead, he should focus on the lower fat mock meats. Beyond meat crumbles, for example:http://beyondmeat.com/products/view/beefy-crumble
Or their grilled strips, although those have more carbohydrates in them.

For most people I would say TVP, but he probably can't budget the carbs.

One can easily do a non-vegan Aktins style diet while eating a good deal of meat and keeping saturated fat below recommendations, you'd just focus more on fish and lean cuts of meat and use plant oils (or whole foods) that are low in saturated fat.

Protein should not be that high. You would have to keep the amount of meat VERY low, and VERY lean, and otherwise focus on the least saturated purified plant fats which would further limit your diet. Most people don't enjoy meat that lean. Even skinless chicken has about 5% of its calories from saturated fat, and it's not giving you as much unsaturated fat to make up for that. You can achieve lower amounts of saturated fat and be more flexible (or lower risk more) by choosing mock meats instead.

The only animal products he can really get without any saturated fat are egg whites and fat free dairy. The latter is still too high in carbohydrates.

Egg whites are an option, though, if he likes egg white omelets. I've never seen a compelling health reason to avoid them since they have no saturated fat or cholesterol... as long as they're well cooked to avoid food poisoning. Pre-processed in a carton is safest.

@PsYcHo More information above in this post. I forgot to mention egg whites, although obviously I'd rather people not eat eggs there isn't any health reason that he'd nee to avoid the whites. That's the only animal product that I can think of that wouldn't increase his risk AFAIK.